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Hepatoblastoma and hepatocellular carcinoma are the most common primary hepatic tumors in children. To date, treatment is not standardized, and outcomes from large patient cohorts are not well documented. The management of children with locally advanced, unresectable disease or those with extra-hepatic distant metastases is often complex and challenging for multidisciplinary teams comprised of pediatric oncologists, hepatologists, surgeons and liver transplant team members. This critical review provides very important insights on current controversies including the role of liver transplantation in children with unresectable hepatoblastoma that present with metastatic disease; and adjudicating the risks/benefits for the roles of chemotherapy and liver transplantation in the treatment of advanced pediatric hepatocellular carcinoma.